Virtual medical assistant methods and apparatus

ABSTRACT

In some aspects, a method of using a virtual medical assistant to assist a medical professional, the virtual medical assistant implemented, at least in part, by at least one processor of a host device capable of connecting to at least one network is provided. The method comprises receiving free-form instruction from the medical professional, providing the free-form instruction for processing to assist in identifying from the free-form instruction at least one medical task to be performed, obtaining identification of at least one impediment to performing the at least one medical task, and inferring at least some information needed to overcome the at least one impediment.

BACKGROUND

Many mobile communications devices, such as smart phones, are equippedwith a virtual assistant (also referred to as a virtual agent)configured to receive speech input from a user and employ variousresources, either locally or accessible over a network, to recognize theuser's speech, attempt to understand the user's intent and respond byperforming one or more desired tasks based on that understanding (e.g.,perform an internet search, make a telephone call, schedule anappointment, etc.). However, conventional virtual assistants areconfigured to respond to voice commands of the general user andtherefore may be limited in their capabilities, often focusing ongeneral information retrieval, personal scheduling or engagingcommunication functionality on the mobile device (e.g., initiating aphone call, sending a text or email message to an individual in theuser's contact list, etc.).

SUMMARY

Some embodiments include a method of using a virtual medical assistantto assist a medical professional, the virtual medical assistantimplemented, at least in part, by at least one processor of a hostdevice capable of connecting to at least one network, the methodcomprising receiving free-form instruction from the medicalprofessional, providing the free-form instruction for processing toassist in identifying, from the free-form instruction, at least onemedical task to be performed, providing at least one first response tothe medical professional regarding the free-form instruction prior tothe at least one medical task being performed, and receiving firstinformation from the medical professional responsive to the at least onefirst response.

Some embodiments include at least one computer readable medium storinginstructions that, when executed by at least one processor, performs amethod of using a virtual medical assistant to assist a medicalprofessional, the virtual medical assistant implemented, at least inpart, by at least one processor of a host device capable of connectingto at least one network, the method comprising receiving free-forminstruction from the medical professional, providing the free-forminstruction for processing to assist in identifying, from the free-forminstruction, at least one medical task to be performed, providing atleast one first response to the medical professional regarding thefree-form instruction prior to the at least one medical task beingperformed, and receiving first information from the medical professionalresponsive to the at least one first response.

Some embodiments include a host device capable of connecting to at leastone network, the host device comprising at least one processorimplementing, at least in part, a virtual clinical assistant to assist amedical professional, the at least one processor configured to, receivefree-form instruction from the medical professional, provide thefree-form instruction for processing to assist in identifying, from thefree-form instruction, at least one medical task to be performed,provide at least one first response to the medical professionalregarding the free-form instruction prior to the at least one medicaltask being performed, and receive first information from the medicalprofessional responsive to the at least one first response.

Some embodiments include a method of using a virtual medical assistantto assist a medical professional, the virtual medical assistantimplemented, at least in part, by at least one processor of a hostdevice capable of connecting to at least one network, the methodcomprising receiving free-form instruction from the medicalprofessional, providing the free-form instruction for processing toassist in identifying from the free-form instruction at least onemedical task to be performed, obtaining identification of at least oneimpediment to performing the at least one medical task; and inferring atleast some information needed to overcome the at least one impediment.

Some embodiments include at least one computer readable medium storinginstructions that, when executed on at least one processor, perform amethod of using a virtual medical assistant to assist a medicalprofessional, the virtual medical assistant implemented, at least inpart, by at least one processor of a host device capable of connectingto at least one network, the method comprising receiving free-forminstruction from the medical professional, providing the free-forminstruction for processing to assist in identifying from the free-forminstruction at least one medical task to be performed, obtainingidentification of at least one impediment to performing the at least onemedical task, and inferring at least some information needed to overcomethe at least one impediment.

Some embodiments include a host device capable of connecting to at leastone network, the host device comprising at least one processorimplementing, at least in part, a virtual medical assistant to assist amedical professional, the at least one processor configured to receivefree-form instruction from the medical professional, provide thefree-form instruction for processing to assist in identifying from thefree-form instruction at least one medical task to be performed, obtainidentification of at least one impediment to performing the at least onemedical task, and infer at least some information needed to overcome theat least one impediment.

BRIEF DESCRIPTION OF DRAWINGS

Various aspects and embodiments of the application will be describedwith reference to the following figures.

FIG. 1 illustrates an exemplary system in which a virtual medicalassistant may be implemented, in accordance with some embodiments;

FIG. 2 illustrates a method of interacting with a medical professionalto assist with one or more medical tasks specified in free-forminstruction from the medical professional, in accordance with someembodiments;

FIG. 3 illustrates a method of inferring information in connection withat least one medical task specified in free-form instruction from themedical professional, in accordance with some embodiments;

FIGS. 4A-4H illustrate examples of interaction between a virtual medicalassistant application installed on a mobile device and a medicalprofessional using the mobile device, in accordance with someembodiments; and

FIG. 5 is an exemplary computer system on which techniques describedherein may be implemented, in accordance with some embodiments.

DETAILED DESCRIPTION

As discussed above, conventional virtual assistants are frequentlyadapted to be useful to a broad range of users and therefore aregenerally limited to performing generic, and often very few, tasks inresponse to user commands. Conventional virtual assistants may thereforebe unsuitable for performing specialized tasks. The inventors haveappreciated the benefit of a virtual assistant adapted for the medicaldomain to assist a medical professional in performing actions or tasksin the context of the medical professional's medical practice and/orhealth care capacity. Such a domain specific virtual assistant may becapable of performing functionality within the medical domain that arebeyond the reach of conventional virtual assistants.

According to some embodiments, a virtual medical assistant isimplemented, at least in part, on a host device and is configured toassist a medical professional in performing one or more medical tasksincluding, but not limited to, assisting a medical professional inordering an orderable item (e.g., a medication, a procedure, labresults, a diagnostic test, a referral, a consultation, etc.),identifying conflicts, accessing and displaying patient information,capturing dictation corresponding to a patient encounter, updating anelectronic medical record (EMR) of a patient, scheduling a patientvisit, obtaining medical information, etc. Details of a virtual medicalassistant according to some embodiments are provided below.

The term “virtual medical assistant” refers herein to one or morecomputer implemented components (e.g., software components, hardwarecomponents, or a combination of both) configured to receive input from amedical professional, initiate appropriate processing of the input toidentify one or more medical tasks specified by the input and/orinitiate one or more processes to facilitate performance of the one ormore identified medical tasks specified by the input. A medicalprofessional refers herein to a person qualified in the practice ofmedicine, psychiatry, or psychology, including, but not limited to,general physicians, surgeons, psychiatrists, psychologists, therapists,or other licensed health care professionals.

The inventors have recognized benefits of a virtual medical assistantimplemented, at least in part, on a host device operated by a medicalprofessional, wherein the virtual medical assistant is configured toreceive free-form instruction from the medical professional and tofacilitate processing of the free-form instruction to identify and/orassist in performing one or more medical tasks that the medicalprofessional specified in the free-form instruction. Free-form meansthat a medical professional is generally unconstrained with respect tothe structure and/or content of the provided instruction. As such, amedical professional may provide instruction using naturalconversational language that need not (but may) conform to anyparticular command grammar and/or command lexicon, and have at leastsome instructions understood by the virtual medical assistant. Acceptingfree-form instruction allows a virtual medical assistant to be utilizedwithout requiring a medical professional to first learn a set ofstructured commands to be understood by the virtual medical assistant.The term “instruction” refers herein to any actionable input including,but not limited to, one or more commands, requests, queries, questions,inquiries, etc. Some examples of free-form instruction are discussed infurther detail below to illustrate various concepts related to virtualmedical assistant methods and apparatus.

As discussed above, the inventors have recognized benefits of a virtualmedical assistant capable of receiving free-form instruction andprocessing the free-form instruction to identify one or more medicaltasks specified in the free-form instruction. Some medical tasksperformed by a medical professional may be relatively complicated inthat they often require certain information to be specified fully and ina particular manner in order for the medical task to be performed. Inaddition, some medical tasks relate to the health and well-being of apatient and care must be taken to ensure the safety and suitability ofcertain medical tasks to be performed. The inventors have appreciatedthat a virtual medical assistant that can interact with a medicalprofessional via a dialog exchange may facilitate more efficientperformance of certain medical tasks. In addition, discourse between thevirtual medical assistant and the medical professional may relieve someof the burden from the medical professional of correctly and safelycarrying out one or more medical tasks that a medical professional wouldlike performed.

According to some embodiments, a virtual medical assistant is configuredto receive free-form instruction from a medical professional andinitiate processing to identify one or more medical tasks specified inthe free-form instruction. The virtual medical assistant may provide,via the host device or other interface device, at least one response inconnection with the free-form instruction prior to the one or moremedical tasks being performed. The response provided by the virtualmedical assistant may include, for example, a request for additionalinformation, a request for clarification and/or disambiguation regardingthe one or more identified medical tasks, one or more alerts or warningswith respect to a conflict in connection with the one or more identifiedmedical tasks, a confirmation regarding the one or more identifiedmedical tasks, an inquiry as to whether the medical professional wouldlike to proceed, or any other comment, question or inquiry regarding thefree-form instruction.

As discussed above, it may be inconvenient or time consuming for amedical professional to specify every detail regarding a medical task tobe performed. In addition, some medical tasks require certaininformation to be specified fully and in a specific manner before thetask can be performed, making it relatively burdensome for a medicalprofessional to accomplish certain medical tasks. According to someembodiments, a virtual medical assistant infers at least someinformation needed to perform one or more medical tasks identified infree-form instruction from a medical professional using informationavailable to the virtual medical assistant. For example, the virtualmedical assistant may infer information from one or more previouslyreceived free-form instructions from the medical professional,information obtained in performing one or more previous medical tasks,patient information from an electronic medical record (EMR) associatedwith a patient and/or information obtained from one or more medicalinformation resources accessible over a network.

Accordingly, a virtual medical assistant so configured may be capable ofassisting a medical professional in performing one or more medical tasksspecified in free-from instruction from the medical professional, andmay facilitate doing so even in the presence of incomplete, ambiguous,inconsistent and/or conflicting instruction from the medicalprofessional by obtaining further information from the medicalprofessional and/or inferring information based on data accessible tothe virtual medical assistant. The virtual medical assistant may also(or alternatively) be configured to provide information to the medicalprofessional that may be useful to the medical professional incompleting one or more medical tasks, such as by identifying conflictsand/or providing one or more alerts or warnings, providing confirmationregarding a medical task to be performed, etc., as discussed in furtherdetail below.

Following below are more detailed descriptions of various conceptsrelated to, and embodiments of, methods and apparatus for implementing avirtual medical assistant. It should be appreciated that various aspectsdescribed herein may be implemented in any of numerous ways. Examples ofspecific implementations are provided herein for illustrative purposesonly. In addition, the various aspects described in the embodimentsbelow may be used alone or in any combination, and are not limited tothe combinations explicitly described herein.

FIG. 1 illustrates a system 100 within which a virtual medical assistantmay be implemented, according to some embodiments. The virtual medicalassistant comprises a virtual medical assistant application 110implemented, at least in part, by one or more processors of a mobiledevice 101. Virtual medical assistant application 110 may be installedas one or more software components on mobile device 101, for example, bydownloading the virtual medical assistant application as an “app” via anetwork, or otherwise installing the application on mobile device 101.Virtual medical assistant application 110 may be configured to accessand utilize one or more network resources communicatively coupled to thevirtual medical assistant 110 via one or more networks 150 (e.g., vianetwork communication capability available on the host device).

Virtual medical assistant application 110 and one or more networkresources accessed by the virtual medical assistant application 110 arecollectively referred to herein as the virtual medical assistant. Thus,actions described as being performed by the virtual medical assistantare to be understood as being performed by the virtual medical assistantapplication 110 and/or any one or combination of network resourcesaccessed, utilized or delegated to by the virtual medical assistantapplication 110, example resources of which are described in furtherdetail below in connection with the system illustrated in FIG. 1. Thus,according to some embodiments, a virtual medical assistant may beimplemented as a distributed system having at least some functionalityimplemented on a host device (e.g., mobile device 101) and at least somefunctionality implemented via one or more network resources.

In FIG. 1, the virtual medical assistant may be accessed by a medicalprofessional using mobile device 101 via virtual medical assistantapplication 110 installed, at least partially, on the mobile device asdiscussed above. Mobile device 101 in FIG. 1 is illustrated as having anumber of components characteristic of a “smart phone,” but it should beappreciated that mobile device 101 may be any suitable host devicecapable of receiving input from a user (e.g., a medical professional),providing information (e.g., rendering information to a user visually,audibly, etc.), and communicating with network resources via one or morenetworks, as the aspects are not limited for use with any particulartype of host device.

In particular, in addition to mobile devices, suitable host device typesinclude personal computers or other generally stationary or fixedcomputing devices accessible by the medical professional. Anotheralternative to hosting a virtual medical assistant includes one or morenetwork accessible computers that are accessed using telephony, whereinthe network computer(s) hosts the virtual medical assistant and thefunctionality is accessed via a separate interface device. For example,a medical professional may call into a system capable of accessing oneor more host devices using any suitable telephony device and conductinteractions with the virtual medical assistant using speech, such thatthe interface device (e.g., the telephony component used by the medicalprofessional) interacts with, but does not itself necessarily host, thevirtual medical assistant. Such a telephony-based implementation may beaccessed via the telephony capabilities of a mobile device (e.g., usingcellular technology), or may be accessed using any other suitabletelephony component).

Mobile device 101 may include one or more transducers 103 for convertingacoustic energy to electrical energy and vice versa. For example,transducers 103 may include one or more speakers and/or one or moremicrophones arranged on the mobile device to allow input/output (I/O) ofacoustic information. Different mobile devices may include differingnumbers and arrangements of transducers, any of which may be suitable tofacilitate acoustic I/O. Mobile device 101 may include further I/Ofunctionality including display 105 for visually presenting informationto the user. Display 105 may also be configured as an input device, forexample, by responding to touch, pen input, etc. Mobile device 101 mayinclude one or more other input components that allow a user tointerface with the mobile device. For example, button 102 may be used asa selection button or may include any other functionality on the mobiledevice. Mobile device 101 may include a keypad (not shown), arrowbuttons or any other input component capable of receiving input from auser, such as a medical professional using the mobile device to interactwith virtual medical assistant application 110.

Mobile device 101 may also include one or more wireless communicationcomponents 106. For example, mobile communication devices such ascellular telephones will typically have a wireless transceiver capableof communicating with one or more cellular networks. Alternatively, orin addition to, wireless communication component 106 may include awireless transceiver capable of communicating with one or more othernetworks or external devices. For example, wireless communicationcomponent 106 may include a component configured to communication viathe IEEE 802.11 standard (Wi-Fi) to connect to network access pointscoupled to one or more networks (e.g., local area networks (LANs), widearea networks (WANs) such as the internet, etc.), and/or wirelesscommunication component 106 may include a Bluetooth® transceiver toconnect to a Bluetooth® compatible device, etc.

To simplify the illustration of exemplary mobile device 101, wirelesscommunication component 106 is used to represent schematically anywireless communication component implemented on mobile device 101 andmay include one or multiple components that may be either separate orintegrated components, may be independent system components, or may bedifferent system components in communication with one or more otherwireless components. That is, wireless communication component 106denotes one or any combination of components that may be implemented ona mobile device that allows the mobile device 101 to communicatewirelessly with one or more networks, systems and/or other devices. Itshould be appreciated that mobile device 101 is merely an example of amobile device suitable for hosting a virtual medical assistantapplication and/or for use with any one or combination of virtualmedical assistant techniques described herein.

Techniques described herein are not limited for use with any particulardevice having any particular number or arrangement of components, andany network aware device having I/O functionality may be suitable tooperate as the host device for a virtual medical assistant applicationto access functionality of a virtual medical assistant. As discussedabove, for example, the host device may be a personal computer or otherstandalone computer having network access (e.g., either wired, wireless,or combination, access to one or more networks), may be a networkcomputer capable of being accessed by telephony components, or any othersuitable computing device.

According to some embodiments, virtual medical assistant application 110is configured to present one or more interfaces to receive input (e.g.,free-form instruction from a medical professional) via the I/Ofunctionality of the host device (e.g., mobile device 101). For example,virtual medical assistant application 110 may be configured to receivespeech from a medical professional via one or more microphones coupledto mobile device 101, and initiate processes to recognize and understandthe content of a medical professional's speech, as discussed in furtherdetail below. Alternatively, or in addition to, virtual medicalassistant application 110 may receive input from the medicalprofessional in other ways, such as via any of the input mechanismsprovided on mobile device 101 (e.g., touch sensitive display, keypad,mouse, one or more buttons or any other interface control provided onthe host device). According to some embodiments, virtual medicalassistant application 110 is configured to provide a graphical userinterface (GUI) on display 105 of mobile device 101 that presents to themedical professional the mechanisms by which the medical professionalmay provide input to the virtual medical assistant.

Virtual medical assistant application 110 may also be configured topresent one or more interfaces to provide information to the medicalprofessional. For example, virtual medical assistant application 110 maydisplay information to the user via the display on the host device(e.g., via a GUI displayed on a display 105 on mobile device 101).Virtual medical assistant application 110 may also provide informationaudibly to the medical professional, for example, using speech synthesistechniques and rendering synthesized speech via one or more speakerscoupled to mobile device 101, or by rendering prerecorded speech or oneor more sounds configured to convey information to the medicalprofessional. According to some embodiments, virtual medical assistantapplication 110 is capable of rendering information to the medicalprofessional both visually and audibly. Virtual medical assistantapplication 110 may include other mechanisms for providing informationto the medical professional, as the aspects are not limited for use withany particular type or technique for providing and/or renderinginformation to the medical professional.

According to some embodiments, a virtual medical assistant may employ avirtual medical assistant application server 110′ coupled to network(s)150 to communicate with virtual medical assistant application 110installed on mobile device 101 to assist with interfacing with one ormore network resources. By implementing at least some functionality ofthe virtual medical assistant on virtual medical assistant server 110′,the computer footprint of the virtual medical assistant application 110installed on the host device may be reduced (e.g., on a mobile devicewhere resources may be limited to some extent). However, in someembodiments, virtual medical assistant application server 110′ may notbe implemented and functionality to interface with the one or morenetwork resources may be implemented by virtual medical assistantapplication 110 resident on the host device, as the aspects are notlimited in this respect.

According to some embodiments, the virtual medical assistant may notinclude a virtual medical assistant application installed on theinterface device used by the medical professional to access thefunctionality of the virtual medical assistant. For example, accordingto some embodiments, a medical professional may access the virtualmedical assistant via a telephony device that does not host, or may beunsuitable for hosting, virtual medical assistant application software,and may interact with the virtual medical assistant via the telephonydevice. In such an implementation, the virtual medical assistantapplication may be implemented by one or more network computing devicesaccessible, either directly or indirectly, by the telephony device(e.g., virtual medical assistant application server ‘110 may implementall, or some portion, of the virtual medical assistant applicationfunctionality), and virtual medical assistant functionality may bedelivered by network components to the interface device used by themedical professional.

According to some embodiments, virtual medical assistant application 110is configured to access, utilize and/or delegate to one or more networkresources coupled to network(s) 150, thus forming a virtual medicalassistant (denoted generally as virtual medical assistant 100 in theexample in FIG. 1) configured to assist in performing medical tasksrequested by or on behalf of a medical professional. Network(s) 150 maybe any one or combination of networks interconnecting the variousnetwork resources including, but not limited to, any one or combinationof LANs, WANs, the internet, private networks, personal networks, etc.The network resources depicted in FIG. 1 are merely exemplary, and avirtual medical assistant may comprise any one or combination of networkresources illustrated in FIG. 1, or may utilize other network resourcesnot illustrated, as techniques described herein are not limited for usewith any particular number or configuration of network resources.

As depicted in FIG. 1, virtual medical assistant 100 includes a medicalunderstanding resource 120 comprising automatic speech recognition (ASR)component 130, natural language understanding (NLU) and/or clinicallanguage understanding (CLU) component 140, and dialog component 160.Each of these components may be implemented in software, hardware, or acombination of software and hardware. Components implemented in softwaremay comprise sets of processor-executable instructions that may beexecuted by one or more processors of one or more network computers,such as a network server or multiple network servers. Each of ASRcomponent 130, NLU/CLU component 140 and dialog component 160 may beimplemented as a separate component, or any combination of thesecomponents may be integrated into a single component or a set ofdistributed components implemented on one or multiple network computers(e.g., network servers). In addition, any one of ASR component 130,NLU/CLU component 140 and dialog component 160 may be implemented as aset of multiple software and/or hardware components. As such, processingdescribed as being performed by medical understanding resource 120refers to processing performed by any one or combination of theconstituent components, operating alone or in concert with otherconstituent components.

The system illustrated in FIG. 1 also comprises a number of medicalresources including electronic health record (EHR) system 170, medicaldecision support (CDS) service 180, order fulfillment system 190 andmedical information retrieval services 155, each of which are discussedin further detail below. It should be appreciated that the networkresources illustrated in FIG. 1 are merely exemplary and a virtualmedical assistant may utilize one or any combination of resourcesillustrated, or may utilize other resources not illustrated ordescribed. It should be further appreciated that the various componentsillustrated in FIG. 1 may be coupled in any suitable manner, and may becomponents that are located on the same physical computing system(s) orseparate physical computing systems that can be coupled in any suitableway, including using any type of network, such as a local network, awide area network, the internet, etc.

As discussed above, virtual medical assistant application 110 mayreceive input (e.g., free-form instruction from a medical professional)in the form of speech, and ASR component 130 may be utilized to identifythe content of the speech (e.g., recognize the constituent words in thespeech input). In particular, a medical professional may speak free-forminstruction to the host device (e.g., mobile device 110) and/or aninterface component capable of accessing, directly or indirectly, thehost device. Virtual medical assistant application 110 may receive thefree-form instruction from the medical professional and provide thefree-form instruction to ASR component 130 to be recognized. Thefree-form instruction may be processed in any suitable manner prior toproviding the free-form instruction to ASR component 130. For example,the free-form instruction may be pre-processed to remove information,format the free-form instruction or modify the free-from instruction inpreparation for ASR (e.g., the free-form instruction may be formatted toconform with a desired audio format and/or prepared for streaming as anaudio stream or prepared as an appropriate audio file) so that thefree-form instruction can be provided as an audio input to ASR component130 (e.g., transmitted over a network).

ASR component 130 may be configured to process audio input (e.g., audioinput representing free-form instruction) to form a textualrepresentation of the audio input (e.g., a textual representation of theconstituent words in the free-form instruction that can be furtherprocessed to understand the meaning of the constituent words). Suchprocessing to produce a textual representation may be performed in anysuitable way. In some embodiments, ASR component 130 may convert speechto a representation other than a textual representation, or the speechmay not be recognized as words, but instead a sequence or collection ofabstract concepts. It should be appreciated that the words and/orconcepts represented in the medical professional's free-form instructionmay be represented and/or stored as data in any suitable form, asaspects are not limited in this respect. ASR component 130 may transmitthe recognized free-form instruction over the network to be received bythe virtual medical assistant application 110 (e.g., for display to themedical professional) and/or ASR component 130 may provide therecognized free-form instruction to one or more other network resourcesfor further processing (e.g., the recognized free-form instruction maybe provided to a NLU/CLU component 140 to assist in understanding thesemantic content of the free-form instruction to identify one or moremedical tasks specified therein), as discussed in further detail below.

According to some embodiments, ASR component 130 may be tailored, atleast in part, to the medical domain. For example, ASR component maymake use of a lexicon of medical terms (which may be part of, or inaddition to, another more general speech recognition lexicon) whiledetermining the sequence of words that were spoken in the free-forminstruction from the medical professional. However, aspects of theinvention are not limited to the use of a lexicon, or any particulartype of lexicon, for ASR. When used, the medical lexicon in someembodiments may be linked to a knowledge representation model (e.g., amedical language understanding ontology, one or more statistical modelsand/or one or more rule-based models) utilized by NLU/CLU component 140and/or dialog component 160, such that ASR component 130 produces atextual representation of the free-form instruction containing at leastsome terms in a form understandable to NLU/CLU component 140 and/ordialog component 160.

In some embodiments, ASR component 130 may use a more general speechrecognition lexicon shared between ASR component and one or more othernetwork resources. However, in other embodiments, ASR component 130 maynot have any lexicon developed to be in common with the other exemplarynetwork resources illustrated in FIG. 1 or otherwise described. In someembodiments, a lexicon used by ASR component 130 may be linked to adifferent type of medical knowledge representation model, such as onenot designed or used for language understanding. It should beappreciated that any lexicon used by ASR component 130 (or any of theother network resources) may be implemented and/or represented as datain any suitable way. ASR component 130 may utilize one or anycombination of suitable acoustic models, lexicons, grammars, languagemodels, etc. to perform recognition, as aspects are not limited for usewith any particular ASR implementation.

As discussed above, the medical understanding resource 120 may includeNLU/CLU component 140 configured to process free-form instruction toidentify one or more medical tasks specified in the free-forminstruction and may also identify one or more parameters associated withthe one or more medical tasks. According to some embodiments, a virtualmedical assistant is configured to process free-form instruction fromthe medical professional. To this end, NLU/CLU component 140 may bedesigned to be relatively robust with respect to its ability to identifytasks in free-form instruction provided in as many of the myriad ways inwhich a medical professional might choose to express the instruction tothe extent desired or to the extent reasonable (or possible). However,there is no limitation on what expressions an NLU/CLU component 140 maybe capable of understanding, as implementations according to someembodiments may be more limited than others in this respect.

NLU/CLU component 140 may use any suitable language understandingtechniques to ascertain the meaning of the free-form instruction so asto assist in identifying one or more tasks specified therein. Forexample, NLU/CLU component may be configured to identify and extractgrammatical and/or syntactical components of the free-form speech, suchas parts of speech, or words or phrases belonging to known semanticcategories, to facilitate an understanding of the free-form instruction.For example, NLU/CLU component 140 may identify action words (e.g.,action words that a medical profession may be inclined to use inspecifying certain medical task), subject words, topic words, medicalterms, clinical facts and/or any other type or category of words theNLU/CLU component 140 may deem relevant to ascertaining the semanticform or content of the free-form instruction to facilitate identifyingmedical tasks specified therein.

To assist in identifying medical tasks in free-form instruction, NLU/CLUcomponent 140 may have specialized functionality tailored to the medicaldomain. For example, NLU/CLU component 140 may include one or moreknowledge representation models that captures semantic knowledgeregarding language in general and/or medical language in the specific.For example, a knowledge representation model may be capable ofassociating medical terms with corresponding categories, classificationsor types. Such categories may include, but are not limited to,medications, allergies, procedures, diagnostic tests, laboratory tests,conditions, disease or disorders, symptoms, vital signs, anatomy, bodysites, medical devices, observable findings, measurable findings, etc.It should be appreciated that the above list is merely exemplary, andsome embodiments may not use one or more of the above-listed categories,and some embodiments may use other suitable categories.

A knowledge representation model may make use of or incorporate a formalontology linked to a lexicon of medical terms. The formal ontology maybe implemented as a relational database, or in any other suitable form,and may represent semantic concepts relevant to the medical domain, aswell as linguistic concepts related to ways the semantic concepts may beexpressed in natural language. Medical terms in the lexicon may belinked to at least one concept in the formal ontology.

A knowledge representation model may use, employ or implement one ormore statistical models to extract semantic entities from naturallanguage input. In general, a statistical model can be described as afunctional component designed and/or trained to analyze new inputs basedon probabilistic patterns observed in prior training inputs. In thissense, statistical models differ from “rule-based” models, whichtypically apply hard-coded deterministic rules to map from inputs havingparticular characteristics to particular outputs. By contrast, astatistical model may operate to determine a particular output for aninput with particular characteristics by considering how often (e.g.,with what probability) training inputs with those same characteristics(or similar characteristics) were associated with that particular outputin the statistical model's training data. For example, in the context ofa virtual medical assistant, the input on which the model operates maycorrespond to free-form instruction (or a representation derivedtherefrom) and the output may include an identification of a medicaltask specified by the free-form instruction and/or one or moreassociated parameters.

To supply the probabilistic data that allows a statistical model toextrapolate from the tendency of particular input characteristics to beassociated with particular outputs in past examples, statistical modelsare typically trained (or “built”) on training corpuses with relativelylarge numbers of example inputs. Typically, the example inputs arelabeled with the known outputs with which they should be associated(e.g., a corpus of free-form instruction input may be labeled with thecorrect medical task the instruction specifies), often by a humanlabeler (e.g., with expert knowledge of the domain), or sometimesautomatically. Characteristics of interest (known as “features”) areidentified (“extracted”) from the inputs, and the statistical modellearns the probabilities with which different features are associatedwith different outputs, based on how often training inputs with thosefeatures are associated with those outputs. When the same features areextracted from a new input (e.g., an input that has not been labeledwith a known output, for example, by a human), the statistical model canthen use the learned probabilities for the extracted features (aslearned from the training data) to determine which output is most likelycorrect for the new input. In the context of a virtual medicalassistant, the features may correspond to the words, concepts,associations, relationships, etc. identified in the free-forminstruction, and the statistical model may determine which one or moretasks is most likely correct for free-form speech received from themedical professional based on these features and their relationships.

A knowledge representation model utilized by NLU/CLU component 140 mayalso include (or alternatively include) one or more rule-based modelsthat provide a set of rules as to how to map words or phrases infree-form instruction to corresponding medical tasks and/or that mapwords or phrases in free-form instruction to parameters of an identifiedmedical task. For example, NLU/CLU component 140 may include arule-based natural language processing system to extract medical facts,link facts to concepts or otherwise assist in identifying one or moremedical tasks specified in free-form instruction received from a medicalprofessional. In a rule-based system, a linguist and/or other individualmay create a plurality of rules that can specify what words orcombinations or words evidence that free-form speech specifies aparticular medical task (e.g., an instruction to order an orderableitem). Rule-based techniques can be employed by NLU/CLU component 140 toidentify one or more medical tasks specified in free-form instructionfrom the medical professional (e.g., a request for patient information,instruction to place an order for an orderable item, instruction to takedictation, command to update a patient record, inquiry regarding amedical entity, etc.) and/or any parameters associated with identifiedmedical tasks.

It should be appreciated that an NLU/CLU component may utilize one orany combination of techniques described above to identify medical tasksin free-form instruction and/or identify any parameters associated withidentified medical tasks, as aspects are not limited for use with anyparticular technique or combination of techniques. In accordance withone embodiment described herein, a hybrid approach is used in whichNLU/CLU component 140 employs both a statistical model and a rules-basedcomponent to identify one or more medical tasks specified in free-forminstruction. Such a hybrid approach can be implemented in any ofnumerous ways, as aspects that employ a hybrid approach are not limitedto any particular implementation technique. In accordance with someembodiments, the statistic model and rules-based component of theNLU/CLU component 140 may operate in parallel on the same free-forminstruction, and in some embodiments they may operate serially. Ineither parallel or serial operation, the statistic model and therules-based component may operate independently or may exchangeinformation to facilitate identifying medical task(s) specified infree-form dictation, and/or parameters associated with a medical task.

According to some embodiments, a rules-based component may perform afirst pass on free-form instruction to identify semantic entities by,for example, extracting medical facts, linking words or phrases intoconcepts, and/or identifying other characteristics of known medicaltasks. Thereafter, the statistical model may be used to process thesemantic entities to determine what one or more medical tasks thefree-form instruction most likely relates to. That is, the outputs ofthe rules-based component can be used as features for the statisticalmodel. For example, when a rule fires or otherwise indicates that therule has been met, this may be a feature evaluated by the statisticalmodel. Some rules may be quite specific, so that a firing of the ruleindicates with high probability that the determination expressed therebyis accurate (e.g., detection of the word “order” in combination withidentifying the name of a medication in the free-form instruction mayindicate with high probability that the medical professional would likethe virtual medical assistant to order the medication).

According to some embodiments, a statistical model may operate toidentify the one or more medical tasks most likely specified by thefree-form instruction and the rule-based component may be used toidentify one or more parameters from the free-form instructionassociated with the identified medical task. A statistical model and arule-based component may be used in other suitable ways, as the aspectsare not limited in this respect. In accordance with some embodiments, adetermination can be made about whether to use a statistical model or arule-based component depending upon the content of the free-forminstruction. For example, some instructions that are very structured maylend themselves to rules, whereas types of instructions with significantvariability in how they are expressed in natural language may be bettersuited to the use of a statistical model.

In accordance with some embodiments, an ontology of the type describedabove can be used in conjunction with a statistical model in any ofnumerous ways. For example, the use of an ontology can reduce the amountof annotated data that can be used in training the statistical model, asthe ontology can demonstrate a number of alternate ways of expressingthe same concept. Thus, it may not be necessary to include annotateddata representing all of the alternate ways of expressing instruction toperform certain medical tasks, and the ontology can be combined with thestatistical model to expand its ability to recognize alternativeexpressions not included in the annotated training data. Of course, thisis merely one use of an ontology, as the ontology can be used in anysuitable manner.

Again, the descriptions provided above for combining the use of arule-based component with a statistical model and optionally with anontology are merely illustrative, as the techniques described herein arenot limited to any particular implementation techniques. The techniquesdescribed herein can be implemented using solely a statistical model,solely a rule-based component, or any combination, as they are notlimited to any particular implementation technique. That is, processingby NLU/CLU component 140 may be as simplistic or as sophisticated asdesired to suitably identify one or more medical tasks when they arepresent in free-form instruction provided by a medical professional.

As mentioned above, medical understanding resource 120 illustrated inFIG. 1 also may include dialog component 160. Dialog component 160 mayinclude conversational functionality that facilitates discourse betweena medical professional and the virtual medical assistant. As discussedabove, the virtual medical assistant may be configured to provide one ormore responses to a medical professional in connection with free-forminstruction received from the medical professional. Dialog component 160may contribute, in full or in part, to the formulation of such responsesbased on the content of the free-form instruction, the context of thesituation, and/or the intent of the one or more responses to be providedto the medical professional.

Dialog component 160 may be coupled to NLU/CLU component 140 so as toobtain information regarding the content of the free-form instruction(e.g., to receive information regarding one or more identified medicaltasks specified in the free-form instruction) to ascertain whether aresponse to the medical professional is needed and, if so, how theresponse should be formulated and what information the response shouldcontain. Dialog component 160 may be capable of carrying out differentdialogs as appropriate to obtain information needed to complete aplurality of medical tasks. For example, a medical task may have anassociated structured representation comprising a plurality of fieldscorresponding to information regarding the respective medical task thatis maintained by dialog component 160 or by a component accessible bydialog component 160. Some fields may correspond to parameters that arerequired to perform the associated medical task and some fields maycorrespond to optional parameters.

Dialog component 160 may operate in conjunction with NLU/CLU component140 to identify one or more medical tasks specified in a medicalprofessional's free-form instruction, and to populate the appropriatefields in the representation associated with the identified medicaltask(s) either with information extracted by NLU/CLU component 140 fromthe free-form instruction, information inferred therefrom, inferred fromthe context or state of the discourse with the medical professional, orinferred from data available from one or more network resources. Dialogcomponent 160 may determine that one or more required fields have notbeen populated as a result of processing received free-form instruction(e.g., certain information could not be obtained or inferred from thefree-form instruction, or otherwise inferred) and, in response,formulate an appropriate response to the medical professional to obtainthe missing information. The response may then be provided to themedical professional via the virtual medical assistant application 110on the host device (e.g., the medical professional's mobile device).Similarly, dialog component 160 may ascertain that certain optionalinformation is missing and deem it appropriate to formulate a responsedesigned to solicit this information from the medical professional.Dialog component 160 may also be configured to formulate a response whenthe information needed to perform a medical task is complete, forexample, to provide a confirmatory response to the medical professionalto ensure that the task is the one intended and the parametersascertained by the virtual medical assistant are correct.

Dialog component 160 may be configured to work in concert with CLU/NLUcomponent 140 to formulate responses designed to solicit informationfrom the medical professional to resolve any ambiguities and/oruncertainty that resulted from processing free-form instruction receivedfrom the medical professional. For example, processing performed byCLU/NLU component 140 may have resulted in uncertainty with respect tothe medical task the medical professional would like performed or mayhave resulted in multiple possibilities in this respect. Processing byCLU/NLU component 140 may have resulted in uncertainty regarding one ormore parameters associated with the medical task or needed to completethe medical task. Such ambiguity and/or uncertainty may have resultedfrom an incomplete understanding of the free-form instruction,incomplete or relatively low confidence recognition of the free-forminstruction (e.g., when the free-form instruction is received asspeech), incomplete or ambiguous instruction from the medicalprofessional, or a combination thereof. CLU/NLU component 140 may conveyany ambiguity and/or uncertainty to dialog component 160 to formulate aresponse designed to resolve any ambiguity/uncertainty or obtainclarification regarding questions or concerns in connection with thefree-form instruction.

As discussed above (and as discussed in further detail below), thevirtual medical assistant may be configured to process free-forminstruction and identify one or more conflicts with respect to thecompatibility and/or suitability of performing one or more medical tasksidentified from free-form instruction received from the medicalprofessional. For example, problematic interactions between one or anycombination of medications, allergies, procedures, conditions, etc., maybe identified in the course of processing the free-form instruction. Asdiscussed in further detail below, such conflicts may be identified inpart by utilizing one or more medical resources such as EHR system 170,CDS resource 180, medical information retrieval resource 155 or otheravailable resources. Dialog component 160 may be configured to receiveinformation regarding such conflicts and formulate one or more responsesto alert the medical professional as to the existence of the conflictand/or to inquire how the medical professional would like to proceed inview of the identified conflict(s).

According to some embodiments, dialog component 160 may assess whether acompound instruction is appropriate under given circumstances. Forexample, based on the assessment that the medical professional isintending to order a medication, dialog component 160 may determine thatit is important to both recite the identified parameters that have beenextracted from the free-form instruction (e.g., by NLU/CLU component140) or inferred therefrom, as well as inquire after one or more missingparameters.

The above described functionality with respect to dialog component 160is merely exemplary and a given dialog component may implement someportion or all of the functionality described above, or may implementadditional functionality not described herein or described in connectionwith another component or resource. In addition, some of thefunctionality described in connection with dialog component 160 may beperformed, in whole or in part, by other components or resources(including the virtual medical assistant application resident on thehost device and/or a virtual medical assistant application server, ifimplemented), as functionality described above, when and if implemented,can be performed by any suitable component or combination of components.

As discussed above, the system illustrated in FIG. 1 also includes anumber of medical resources, including EHR system 170. EHR system 170may include one or more components that store the electronic medicalrecords for patients of one or more health care institutions. Manyhealthcare institutions are transitioning or have transitioned frompaper documentation to electronic medical record (EMR) systems, in whichpatients’ medical information is stored in a data repository inelectronic form. The information that was previously memorialized inpaper form as the patient's “chart” may be archived as an electronichealth record (EHR) for the patient, along with any other relevantpatient data. For example, an EHR for a patient may include any one orcombination of the patient's demographic information, intake forms,history, immunization records, laboratory results, medicalprofessional's notes memorializing patient encounters/visits, surgical,pathology and/or radiology reports, diagnostic reports, imaging resultsor other diagnostic test results, consult notes, discharge summaries,etc.

Thus, an EHR is an electronic medical record that generally ismaintained by a specific healthcare institution and contains datadocumenting the care that a specific patient has received from thatinstitution (or other institutions) over time. EHR system 170 mayinclude electronic medical records for patients from a given institutionor from multiple institutions. EHR system 170 may include one or anycombination of separate EHR systems, corresponding to respective singleor multiple institutions, or may include one or any combination of EHRsystems that are integrated or otherwise communicatively coupled. EHRsystem 170 may also include other functionality in addition toarchiving, managing and updating electronic medical records and/or maystore other medical information of a more general nature (e.g., notspecific to a particular patient), or other information specific to aninstitution (e.g., standards, standard operating procedures, policies,etc).

Another medical resource illustrated in FIG. 1 includes medical decisionsupport (CDS) service 180. CDS service 180 is a resource for assessingmedical conflicts. For example, CDS service 180 may include informationabout the suitability and compatibility of medications, medical/surgicalprocedures, and/or diagnostic tests, etc., and interactions therewith.For medications, CDS service 180 may include information regardingdosages, forms and routes of administration, compatibility betweendifferent types of medication, compatibility of medications withparticular allergies, etc. With respect to procedures, CDS service 180may include information regarding compatibility between certainprocedures and pre-existing medical conditions, compatibility withmedications, etc. CDS service 180 may provide other types of informationin this regard, as the aspects are not limited in this respect. In somesystems, CDS functionality may be provided in whole or in part by EHRsystem 170, or EHR system 170 may integrate CDS service 180 or becapable of utilizing CDS service 180 as a resource, and the illustratedconfiguration in FIG. 1 is merely exemplary. It should be appreciatedthat CDS service 180, if implemented, may include any amount ofinformation including one, some or all of the types of informationdescribed above.

Another medical resource illustrated in FIG. 1 includes orderfulfillment system 190. Order fulfillment system 190 may include one ormore systems capable of fulfilling orders submitted in an applicableelectronic format. Order fulfillment system 190 in FIG. 1 denotes anyone or combination of available order fulfillment systems or resourcescapable of fulfilling applicable orderable items. The one or more orderfulfillment systems may be a single system or multiple systems andis/are illustrated together for convenience. According to someembodiments, order fulfillment system 190 includes a ComputerizedPhysician Order Entry (CPOE) system capable of receiving and processingelectronic orders for one or any combination of medications, laboratorytests, radiology screenings, surgical or other medical procedures and/orother planned treatment action items.

As discussed above, some embodiments include a virtual medical assistantconfigured to identify instruction to order one or more orderable itemspecified in free-form instruction, and assist the medical professionalin placing the order. In this respect, the virtual medical assistant maybe configured to access order fulfillment system 190 to facilitate thedispatch of orders received by the virtual medical assistant from themedical professional. To facilitate electronic ordering, the virtualmedical assistant may be configured to utilize any industry standardelectronic interfaces to connect with and communicate with orderfulfillment system 190, or may use any specialized or proprietaryinterfaces or formats needed to utilize one or more order fulfillmentsystems. For example, a virtual medical assistant may generate an orderto be presented as an electronic message in accordance with the HL7standard or in any other suitable manner. Examples of industry standardelectronic interfaces include ePrescribing or CPOE for prescriptions,the CPOE system for ordering procedures, and any of numerous systems forordering lab tests, order management scheduling systems, etc.

The exemplary system illustrated in FIG. 1 also includes medicalinformation retrieval resource 155 that may be utilized by a virtualmedical assistant in accordance with some embodiments. Medicalinformation retrieval resource may include one or more resources thatare available to provide or procure medical information and may includeone or more medical information repositories and/or one or more searchfacilities configured to respond to queries to locate medicalinformation stored in the one or more medical information repositories.According to some embodiments, a virtual medical assistant may utilizemedical information retrieval resource 155 to facilitate responding tomedical professional inquiries, to identify one or more conflicts, toinfer information needed to perform one or more medical tasks, or forone or more other purposes pursuant to assisting a medical professional.However, a virtual medical assistant need not be configured to accesssuch a medical information retrieval resource 155, as the aspects arenot limited in this respect.

As discussed above, the inventors have recognized benefits of a virtualmedical assistant configured to assist a medical professional inperforming one or more medical tasks that the medical professional mayneed assistance in performing including, but not limited to, any one orcombination of accessing patient information, preparing and/orsubmitting an order for an orderable item (e.g., preparing and/orsubmitting a medication order, a procedure order, a lab order, adiagnostic test order, an appointment order, a referral order, aconsultation order, etc.), capturing, evaluating and/or archivingdictation associated with a patient encounter, scheduling appointments,etc. The virtual medical assistant may be configured to interact withthe medical professional in real-time to assist in the completion ofmedical tasks desired by the medical professional. Such interactivityallows for the virtual medical assistant to respond to instructionsreceived from the medical professional to obtain missing information,disambiguate instruction, identify desired medical tasks, identifyconflicts and alert or warn the medical professional regarding theconflicts, confirm an understanding of instructions received, etc.Additionally, interaction with the medical professional may allow thevirtual medical assistant to infer information needed to perform one ormore medical tasks, for example, using information in previouslyreceived instruction, information obtained in performing one or moremedical tasks in response to previously received instruction,information in electronic medical records and/or medical informationaccessed over a network. Some exemplary techniques with respect toimplementing a virtual medical assistant according to some embodimentsare described in further detail below.

FIG. 2 is a flow chart illustrating a method performable by a virtualmedical assistant to assist a medical professional, wherein the virtualmedical assistant is implemented, at least in part, by at least oneprocessor of a host device, according to some embodiments. The hostdevice may be a mobile device, for example, the medical professional'ssmart phone having a virtual medical assistant application installed asan application or “app” on the smart phone, or may be any other suitabledevice capable of hosting a portion of a virtual medical assistant(e.g., a virtual medical assistant application). The host device mayinclude one or more wireless transceivers capable of communicating withat least one network and/or external device so that the virtual medicalassistant application can access one or more network resources for whichthe virtual medical assistant application is configured to cooperatewith.

In act 210, free-form instruction is received by the virtual medicalassistant from the medical professional (e.g., via interfacefunctionality on a mobile device or other interface device). Forexample, the medical professional may speak the free-form instructionand the virtual medical assistant application may receive the free-formspeech instruction via one or more microphones coupled to the mobiledevice. Alternatively, the free form instruction may be received viaanother input component (e.g., via one or more other input mechanismscoupled to a mobile device). For example, the medical professional maytype the free form instruction via a key pad or touch sensitive displayscreen on a mobile device and the virtual medical assistant applicationmay receive the free-form instruction as a free-form textualinstruction. The free-form instruction may be received in any othersuitable way, as the aspects are not limited in this respect (e.g.,free-form instruction may be received via an interface componentseparate from the host device on which the virtual medical assistantapplication is at least partially implemented).

In act 220, the received free-form instruction is provided by thevirtual medical assistant application for processing to identify one ormore medical tasks specified in the free-form instruction by the medicalprofessional. According to some embodiments, after performingpre-processing of the free-form instruction (if any such pre-processingis needed or desirable), the virtual medical assistant application maytransmit the free-form instruction to be processed by one or moreresources connected to a network accessible by the host device. Forexample, the virtual medical assistant application may provide thefree-form instruction to a medical understanding resource to analyze thefree-form instruction to determine its content and meaning, for example,by utilizing an ASR component, NLU/CLU component and/or a dialogcomponent to process the free-form speech to identify a medical taskand/or one or more parameters associated with the identified medicaltask. According to some embodiments, other network resources areutilized to assist in identifying one or more medical tasks specified inthe received free-form instruction.

In some instances, processing the free-form instructions results inidentification of one or more impediments to performing the identifiedat least one medical task. The term “impediment” refers herein to anycondition that generally impedes, complicates and/or otherwise givesrise to questions or concerns with respect to performing at least oneidentified medical task. Examples of impediments are missing informationneeded (or optionally used) to perform at least one medical task or anaspect of at least one medical task, ambiguity with respect toperforming at least one medical task, conflicts associated with at leastone medical task, uncertainty as to the nature of one or more specifiedmedical tasks, etc. As should be appreciated from the examples givenabove, an impediment need not operate to absolutely prevent or bar theat least one medical task from being performed, but need only give riseto a question or concern in this respect (e.g., a free-form instructionmay include sufficient information to complete the order, but acompatibility or suitability conflict may have been identified).However, some impediments may indeed prevent performance of theidentified medical task (e.g., missing information required to completean order for an orderable item may be identified). It should beappreciated that in some instances multiple impediments may beidentified and in other instances no impediments may be identified.

In act 230, at least one first response is provided to the medicalprofessional by the virtual medical assistant by, for example, thevirtual medical assistant application presenting the at least one firstresponse to the medical professional via the host device (e.g., a mobiledevice) prior to the at least one identified medical task beingperformed (or by presenting the at least one first response via anyinterface device utilized by the medical professional). For example, theat least one first response may be displayed to the medical professionalon a display of a mobile device and/or the at least one first responsemay be presented as audio to the medical professional using speechsynthesis techniques and rendering the speech via one or more speakerscoupled to the mobile device. According to some embodiments, the atleast one first response may be both visually and audibly rendered tothe medical professional, or a single mode of presentation may be used,as the aspects are limited for use with any particular presentation orrendering technique.

The one or more techniques for rendering information to the medicalprofessional may depend on the interface device utilized by the medicalprofessional and/or the environment of the medical professional. Forexample, the display capabilities of a mobile device may be limited inwhich case an audio presentation may be preferable, or the medicalprofessional may be utilizing the virtual medical assistant in anenvironment where the focus of the medical professional is trainedelsewhere (e.g., while driving, while performing an examination orprocedure, etc.) such that an audio presentation may be preferred (withor without a corresponding visual rendering of the at least one firstresponse). According to some embodiments, the interface utilized by themedical professional may include only voice capabilities such thatinteraction between the medical professional and the virtual medicalassistant is conducted audibly. In some circumstances, the medicalprofessional may be using the virtual medical assistant in circumstanceswhere audio presentation may be inappropriate or difficult to hear orunderstand, such that a visual rendering of the at least one responsealone may be preferable. However, responses from the virtual medicalassistant may be provided and rendered in any suitable way, format ormode, as the aspects are not limited in this respect.

The at least one first response, however presented, may be any responsedeemed appropriate by the virtual medical assistant in connection withthe identified at least one medical task. For example, the virtualmedical assistant may identify one or more impediments to performing theat least one medical task and formulate (e.g., using a dialog component)the at least one first response to include one or more inquiriesprovided to the medical professional with respect to the one or moreidentified impediments. In this respect, the at least one first responsemay be formulated to include a request that the medical professionalprovide at least some missing information needed to perform at least onemedical task or an aspect of at least one medical task, a request forinformation to assist in resolving one or more ambiguities associatedwith performing at least one medical task, a question about what type ofmedical task the medical professional would like performed, one or morealerts, warnings and/or cautions associated with at least one identifiedmedical task, etc.

The at least one first response alternatively may be unrelated to anyimpediment. For example, the virtual medical assistant may identify oneor more medical tasks without detecting any impediment to performing theat least one medical task, but nevertheless, the medical virtualassistant may want to request confirmation from the medical professionalbefore initiating performance of the identified medical task. Thus, theat least one first response may be formulated to include a statementregarding an understanding of the free-form instruction and/or arecitation of the at least one medical task that the virtual medicalassistant intends to initiate performance of and/or any details that arerelevant (e.g., one or more parameters associated with the task). The atleast one first response may be formulated to include a request that themedical professional confirm that the understanding is correct and/or arequest for confirmation to proceed with performance of an identifiedmedical task.

In act 240, the virtual medical assistant receives information from themedical professional responsive to the at least one first response. Forexample, the medical professional may respond by providing missinginformation, disambiguation information, guidance with respect to atleast one medical task, confirmation to proceed, verification as to theunderstanding of the free-form instruction, cancellation of thefree-form instruction, modification to the free-form instruction, etc.The information from the medical professional may be received by thevirtual medical assistant application via any suitable interface device(e.g., using a mobile device) using any of the input mechanismsdescribed above in connection with receiving free-form instruction.

In act 245, the virtual medical assistant may assess whether the atleast one medical task should be performed based, at least in part, onthe information received from the medical professional. In particular,the virtual medical assistant may evaluate the information to assesswhether the at least one medical task should be performed. For example,the virtual medical assistant system may check to see if all of theinformation needed to perform a requested medical task has beenobtained, or whether further information is needed, whether ambiguitiesare resolved or further clarification is required, whether the medicaltask to be performed has been correctly identified, whether anyconflicts have been cleared or the instruction modified to remove theconflict, whether the medical professional has confirmed that arequested medical task should be performed, etc. If one or moreimpediments have been sufficiently overcome and/or the medicalprofessional has confirmed the understanding of the free-forminstruction and authorized the virtual medical assistant to proceed, thevirtual medical assistant may initiate performance of at least onmedical task identified in the free-form instruction (act 250).

If the virtual medical assistant deems that further information isneeded to perform an identified medical task, any one or combination ofacts 210-240 may be again performed. For example, the virtual medicalassistant may return and await further free-form instruction from themedical professional (e.g., in the event the medical professionaldecided to not proceed with an identified medical task). Alternately,the virtual medical assistant system may again process the free-forminstruction in view of the further information and/or one or morefurther responses may be generated and provided to the medicalprofessional by the virtual medical assistant to invoke the medicalprofessional to provide further information regarding the free-forminstruction. The virtual medical assistant system may also assesswhether further information may now be inferred based on the additionalinformation received from the medical professional.

It should be appreciated that this type of dialog between the medicalprofessional and the virtual medical assistant may continue until it isdetermined that one or more medical tasks are ready to be performedand/or authorized by the medical professional. In this manner, thevirtual medical assistant may interact with the medical professional inreal-time to assist the medical professional in performing medical tasksand/or in performing medical tasks on behalf of the medicalprofessional. It should be further appreciated that identifying at leastone medical task and interacting with the medical professional mayinclude other acts not explicitly described in connection with themethod illustrated in FIG. 2. Furthermore, no one or any particularcombination of acts are required to be performed, nor do acts need beperformed in the order described in connection with FIG. 2, or in anyparticular order, as the aspects are not limited in this respect.Instead, method 200 merely provides an example of an interaction betweena medical professional and a virtual medical assistant system accordingto some embodiments.

As one example of performing method 200, a medical professional mayprovide the following free-form instruction in connection with a patientplanning an ascent of Mount Kilimanjaro with a night stay in the crater:“Start John Doe on Diamox, 250 mg pills taken once daily beginning twodays prior to ascent.” The virtual medical assistant may process thefree-form instruction and recognize that Diamox is the brand name forthe active ingredient acetazolamide. The virtual medical assistant mayaccess John Doe's patient records and determine that the patient isallergic to sulpha-based drugs. In response, the virtual medicalassistant may formulate a response including an alert to the medicalprofessional to this detected drug-allergy interaction by providing thefollowing response: “Patient John Doe is allergic to sulpha-based drugs.Do you want to continue?” In response, the medical professional maydecide to change the prescription by providing the followinginstruction: “Okay, order Dexamethasone instead.”

The virtual medical assistant may receive the further instruction fromthe medical professional, process the instruction to ascertain that themedical professional has changed the prescription to the steroidDexamethasone. In processing the further free-form instruction, thevirtual medical assistant may ascertain that the medical professionalhas failed to provide a number of details needed to complete anddispatch the medication order (e.g., dose, frequency, route, etc.). Thevirtual medical assistant may provide a response to the medicalprofessional as follows: “Change medication order for patient John Doeto Dexamethasone. To complete this order, please provide prescriptiondetails.” The medical professional may respond with the instruction “4mg pills taken orally twice a day starting the day before ascent.” Thisexample discourse may continue until the virtual medical assistant hasobtained the information needed to complete and dispatch the medicationorder, including, according to some embodiments, a recitation of thecompleted order and a request for the medical professional to confirmthe order and/or for the medical professional to provide any neededverification information.

As one example of performing method 200 wherein the virtual medicalassistant requests further guidance regarding the medical task(s) to beperformed, a medical professional may provide the following free-forminstruction: “I need to consult with Dr. Jones to discuss an ultrasoundguided biopsy for kidney mass and surrounding lymph nodes.” The virtualmedical assistant may receive this free-form instruction, process theinstruction and determine that clarification on the intended directivesof the medical professional is needed. For example, the virtual medicalassistant may want clarification as to whether the medical professionalwants to schedule a consultation with Dr. Jones, order the biopsyprocedure, or both. In response, the virtual medical assistant mayprovide a response to the medical professional as follows: “Would youlike me to schedule a consultation with Dr. Jones?” If the medicalprofessional responds in the positive, the virtual medical assistant caninitiate processes to set-up the consultation. The virtual medicalassistant, having identified multiple potential tasks to be performed,may follow-up with the inquiry: “Would you like me to order theultrasound biopsy for kidney mass and surrounding lymph nodes?” to whichthe medical professional may reply: “No, let's wait until after theconsultation.” The virtual medical assistant may note the date and timeof the scheduled consultation and set up an internal reminder tofollow-up after the consultation has taken place. After the consultationhas occurred, the reminder set by the virtual medical assistant maytrigger the virtual medical assistant to provide the following inquiryto the medical professional “Would you like to order the ultrasoundguided biopsy of the kidney mass and surrounding lymph nodes pursuant toyour consultation with Dr. Jones?” In this way, the virtual medicalassistant can proactively assist the medical professional in his/herpractice.

As an example of performing method 200 wherein the at least one responseis not related to an impediment, a medical professional may provide thefollowing free-form instruction to the medical professional: “Set up afull blood panel for Jane, with RBC and WBC count and urine test.” Thevirtual medical assistant may receive and process the free-forminstruction and ascertain that the medical professional would like toorder lab tests for Jane Doe and may respond with the following:“Laboratory test for patient Jane Doe: Full blood panel including redblood cell and white blood cell count and urine test. Any specialinstructions?” The medical professional may respond with the following:“Yes, 12-hour fast required.” The above exemplary interaction mayfacilitate the provision of a comprehensive order for a lab test for thepatient. According to some embodiments, the virtual medical assistantmay follow-up the above dialog to provide an additional response thatrecites the order that the assistant intends to place (including thespecial instructions received) and request that the medical professionalconfirm the order.

It should be appreciated that the above exemplary dialogs between themedical professional and a virtual medical assistant are merelyexemplary of the types of discourse that a virtual medical assistant mayimplement in assisting a medical professional. Any suitable exchangebetween a medical professional and a virtual medical assistant may beperformed to assist a medical professional in performing one or moremedical tasks, as the aspects are not limited to any particular type orform of interaction. Some further examples are described below forillustration.

Method 200 described above in connection with FIG. 2 illustrates certaindiscourse capability of a virtual medical assistant system that allowsthe virtual medical assistant to interact with the medical professionalto probe, inquire, question, request, confirm and/or verify inconnection with free-form instruction received from the medicalprofessional. According to some embodiments, a virtual medical assistantsystem may be implemented that can infer information in connection withfree-form instruction provided by a medical professional. In thismanner, the virtual medical assistant may be able to handle and act uponfree-form instruction that may be incomplete, ambiguous, inconsistentand/or that gives rise to one or more conflicts in connection with oneor more medical tasks specified in received free-from instruction.

FIG. 3 includes a flow chart illustrating a method that may be performedby a virtual medical assistant to assist a medical professional byinferring at least some information in connection with free-forminstruction received from the medical professional. Acts 310 and 320 maybe similar in some respects to acts 210 and 220 described above inconnection with method 200 illustrated in FIG. 2 in that free-forminstruction may be received from a medical professional by the virtualmedical assistant and processed to identify at least one medical task tobe performed. For example, free-form instruction may be received fromthe medical professional via a host device on which a virtual medicalassistant application is operating (or via other interfacecomponent(s)), and the free-form instruction may be transmitted over anetwork to be processed by one or more components forming, at least inpart, the virtual medical assistant to identify any medical tasksspecified in the free-form instruction.

In act 330, at least one impediment to performing a medical taskascertained from the free-form instruction is identified. For example,the virtual medical assistant may process the free-form speech (e.g.,using a medical understanding resource) to understand the content of thefree-form speech to ascertain what the medical professional isinstructing the virtual medical assistant to do or assist with. In doingso, one or more impediments to carrying out the directives of themedical professional may be identified. For example, the virtual medicalassistant may determine that information needed to perform a requestedmedical task is missing, may identify one or more ambiguities in themedical professional's instruction, or may otherwise detect one or moreconditions that impede, complicate and/or raise uncertainty with respectto performing one or more identified medical tasks.

In act 340, at least some information is inferred to assist inovercoming the identified at least one impediment. For example, thevirtual medical assistant may infer information based on informationavailable to one or more components of the virtual medical assistant, oravailable via one or more network resources accessible by the virtualmedical assistant. According to some embodiments, the virtual medicalassistant evaluates previously received instruction from the medicalprofessional and/or information obtained responsive to previouslyreceived instruction to infer the at least some information.

To illustrate an example of inferring at least some informationregarding one or more impediments to performing a medical task, amedical professional may have provided the virtual medical assistant theinstruction: “Show me John Doe's chart.” In response to the instruction,the virtual medical assistant may have initiated processes to obtainJohn Doe's patient history or other relevant records from, for example,an EHR system accessible by the virtual medical assistant, and presentedat least a portion of John Doe's “chart” to the medical professional. Inresponse or subsequent to receiving patient information for John Doe,the medical professional may speak the free-form instruction “Pleaserefill prescription.” The virtual medical assistant may process theinstruction and identify that the medical professional would like toorder a medication, but also ascertain that there is information missingthat is needed to perform the requested medical task. In particular, thepatient name is not explicit in the instruction, and the medication,dose, frequency, administration, quantity, etc. are missing entirely.

The virtual medical assistant may infer one or more of these missingparameters from previous instruction or information obtained fromperforming tasks responsive to previous instructions. For example, thevirtual medical assistant may recognize that the medical professional islikely referring to John Doe due to the previous instruction to “Show meJohn Doe's chart.” In addition, the virtual medical assistant mayunderstand that the medical professional is ordering a refill on aprescription and that the prescription information may be present in thepatient history obtained in response to the instruction to obtain JohnDoe's chart, or otherwise obtainable from an EHR system storing recordsfor John Doe. Accordingly, the virtual medical assistant may infer atleast some of this information from the electronic medical record forJohn Doe.

In the example above, in attempting to infer at least some informationin connection with the prescription that the medical professionalintends to fill, the virtual medical assistant may discover from JohnDoe's EMR that John Doe has multiple medication prescriptions. Thevirtual medical system may provide a response to the medicalprofessional to obtain clarification (e.g., the virtual medicalassistant may perform functionality similar to or the same as act 230 inmethod 200 illustrated in FIG. 2). For example, the virtual medicalassistant may present to the medical professional the multipleprescriptions that were located (or an identifying shorthand such as themedication name) along with a visual and/or audible response such as“John Doe has multiple prescriptions. Please select the prescription youwould like to refill.” The medical professional may then identify thedesired prescription to allow the virtual medical assistant to proceedwith the medication order. Otherwise, if John Doe has only a singleprescription, the virtual medical assistant may infer that this is theprescription the medical professional intends to refill and obtain theneeded information from John Doe's electronic medical record.

Prior to performing the medical task of ordering the medication, thevirtual medical system may present its understanding of the instructionand the details of the prescription refill (e.g., the parameters of themedication order) to the medical professional to confirm that theinstruction was understood correctly and to confirm that any inferredinformation is correct. In the above example, the virtual medicalassistant may present to the medical professional the confirmation“Medication order for patient John Doe, Albuterol inhaler to be taken byoral inhalation as needed. Please confirm medication order.” If themedical professional confirms (e.g., act 345 results in a yes), thevirtual medical assistant may initiate processes to submit themedication order, such as generating a complete medication order andsubmitting it to a CPOE system.

The virtual medical assistant may also infer one or more parametersbased on medical knowledge obtained from one or more medical informationresources available to the virtual medical assistant (e.g., via one ormore information retrieval resources). For example, the medicalprofessional may say “Start John Doe on Compazine 2-3 times daily asneeded for nausea.” While the medical professional does not explicitlystate that the medication should be taken orally, the virtual medicalassistant may infer oral administration by ascertaining that Compazineis the brand name for the oral form of the drug prochlorperazine. Inresponding to the medical professional (e.g., in a confirmatory responseor, for example, to inquire as to the dose), the virtual medicalassistant may include this inference in its recitation of the medicationorder provided to the medical professional (e.g., “Medication order forpatient John Doe. Oral administration of Compazine in pill form 2-3times a day as needed for nausea. What dose of the prochlorperazineshould be administered?”).

As a further example, free-form instruction may mention an “IV,” (i.e.,the medical route intravenous), and the virtual medical assistant mayinfer that the medication should be administered in a liquid form (whichmay be a parameter needed to complete an order for a medication) so thatin some embodiments described herein, the liquid form can be included inthe order for the medication because it is implied. As another example,if the free-form instruction indicates that medication should beadministered “stat,” the virtual medical assistant may infer that themedication needs to be administered immediately, which may enable thevirtual medical assistant to populate the start time field in an orderform for the medication.

The virtual medical assistant may also infer information based on itsknowledge of the medical professional and/or the medical professional'spractice. For example, the medical professional may say “Jane Doe needsa CT scan of chest and neck, with co.” The virtual medical assistant mayreceive the free-form instruction, process the free-form instruction toascertain that the medical professional would like to order a diagnostictest. While the medical professional does not specify a radiology siteto perform the diagnostic test, the virtual medical assistant may inferthe radiology site based on the medical professional's primaryaffiliation with an institution, previous indication of a site toperform radiology tests, or other information available to the virtualmedical assistant that would suggest one site over another. The virtualmedical assistant may present its inference to the medical professionalin a confirmatory response or in a response to obtain any furtherinformation needed to complete and dispatch the order for the diagnostictest.

Method 300 described above in connection with FIG. 3 illustrates certaininference capabilities of a virtual medical assistant system accordingto some embodiments that allow the virtual medical assistant to performmedical tasks, conduct actions on behalf of or otherwise assist amedical professional in circumstances where medical professionalinstruction is incomplete, ambiguous or otherwise gives rise toquestions, by inferring at least some information about the one or moremedical tasks to be performed. As examples above illustrate, techniquesfor inferring information may be used alone or in combination withtechniques for interacting with the medical professional throughdiscourse (e.g. providing responses to the medical professional inconnection with received free-form instruction) to provide a system thatmay allow a medical professional to conduct his/her practice moreefficiently, conveniently and/or safely, though achieving such benefitsis not a requirement of techniques described herein, or of anyimplementation.

As discussed above, according to some embodiments, a virtual medicalassistant may be configured to perform one or more tasks that may assistin a medical professional's practice of medicine. Exemplary tasksinclude, but are not limited to, sending messages (text, email, voice,etc.), scheduling meetings, capturing and/or processing medicaldictation, accessing medical information in EMRs and/or locating andpresenting information from and EHR system, preparing and submittingorders (e.g., medication orders, lab orders, procedure orders,diagnostic test orders, consultation orders, referral orders, etc.),providing medical decision support through medical search and alerts,etc. It should be appreciated that a virtual medical assistant mayimplement one or any combination of the above exemplary tasks, or othersnot explicitly described herein, and there are no requirement that avirtual medical assistant perform any particular task.

According to some embodiments, a virtual medical assistant can operateas an interface to an EHR system to access EMRs to obtain patientinformation requested by the medical professional and/or to assist inthe performance of medical tasks requested by the medical professional.The virtual medical assistant may maintain patient context acrossmultiple instructions from the medical professional to facilitate ameaningful presentation to the medical professional and to allow thevirtual medical assistant to infer information in connection withmedical professional instruction.

In this respect, the virtual medical assistant may operate as an EMRportal to retrieve patient information for review by the medicalprofessional and/or to assist in performing one or more medical tasksincluding, but not limited to, any one or combination of obtaining andpresenting a list of current patients, selecting a patient for moredetailed viewing, searching for patients that match specified criteriaand obtaining information on selected patients. For selected patients,more detailed information may be obtained via the virtual medicalassistant. For example, the virtual medical assistant may present apatient chart (or portion thereof) or other patient data from theassociated EMRs such as current problem or disorder list, currentmedication list, allergy list, current order, patient history notes suchas medical notes, consult notes, operative reports, surgical, pathology,radiology reports, progress notes, treatment summaries, dischargesummaries, diagnostic test results, imaging results, etc. In thisrespect, the virtual medical assistant may be configured to navigate agiven EHR system and individual EMRs to obtain patient informationrequested by the medical professional.

As discussed above, some embodiments include a virtual medical assistantconfigured to assist a medical professional in electronically orderingan orderable item. For example, the virtual medical assistant mayreceive free-form instruction from the medical professional thatincludes instruction to place an order, and may process the free-forminstruction to prepare, complete and/or dispatch the order, which mayinclude making one or more inferences about the order or orderable itemand/or interacting with the medical professional to obtain furtherinformation in this regard. The virtual medical assistant may beconfigured to interface with an order fulfillment system to dispatch theorder once the order is complete.

According to some embodiments, a virtual medical assistant may beconfigured to understand multiple types of orders for any one orcombination of orderable items including in-patient orders formedication in a medical facility (e.g., a hospital) and out-patientmedication orders (e.g., prescriptions), orders for medical procedures(e.g., an MRI, a CT scan or any of numerous other types of procedures),orders for laboratory work or other tests, referral orders to othermedical professionals (e.g., other physicians or specialists, physicaltherapy, etc.), communication orders (e.g., orders for instructions,counseling, guidance or training for any of numerous topics such assmoking cessation or dietary counseling), etc.

As discussed above, in accordance with some embodiments describedherein, a virtual medical assistant may process free-form instructionreceived from a medical professional using a medical understandingresource that includes an NLU/CLU component to identify the orderspecified in the free-form instruction. The NLU/CLU component mayidentify one or more parameters in the order, or may identifyinformation that may be used as a basis for determining or obtainingparameters in the order. The medical understanding resource (e.g., adialog component used by the medical understanding resource) may have anunderstanding of the parameters that need to be specified to generate anorder of the applicable type. For example, the medical understandingcomponent (or other portion of the virtual medical assistant) maymaintain a representation of each order type with which the virtualmedical assistant is configured to assist that includes a field for eachparameter required and/or optional in a connection with placing thecorresponding order.

If the free-form instruction does not fully specify all of theparameters for an order of the orderable item, in accordance with someembodiments, missing parameters can be inferred by the virtual medicalassistant using information from previous instructions, or informationfrom resources available to the virtual medical assistant, and/orobtained through dialog with the medical professional. Exemplaryparameters for ordering a medication may include the name of themedication (e.g., a commercial medication or drug name or a genericname), a dose, a route, a frequency, a duration and an indication (e.g.,specifying a symptom, condition, disease, etc. that indicates that themedication should be taken). Exemplary parameters for a procedure mayinclude an identification of the type of the procedure, as well as alocation and date for the procedure. Exemplary parameters for alaboratory procedure or test may include an identification of the typeof procedure or test, a date, a frequency if it is to be repeated, andany special instructions regarding the laboratory procedure or test.Exemplary parameters for ordering instructions, counseling, guidance,training, etc. may vary depending upon the nature of the communicationorder and whether it is to be given verbally or via some referencematerials (e.g., written leaflets or other material to be provided tothe patient). Parameters for a follow-up visit may include informationidentifying the type of visit (e.g., is it a special purpose visit toaddress something in particular, a general check-up, etc.), a date andany special instructions.

When an order is complete, a virtual medical assistant may generate anorder and dispatch the order for electronic fulfillment. As discussedabove, a virtual medical assistant may interface with a CPOE or otherorder fulfillment system to automatically place orders forprescriptions, laboratory tests, radiology screenings, surgical or othermedical procedures and/or other planned treatment action items, based onprocessing free-form instruction to obtain parameters needed to completethe order. In accordance with some embodiments, the virtual medicalassistant may employ one or more coding systems to facilitate placing anorder in its proper form. Such systems can be used to normalizeterminology and/or provide one or more codes for an orderable item thatmay be required by a particular order fulfillment system. For example, amedication with a name “X” may be orderable in a particular orderfulfillment system only by using a different name or code “Z”. A codingsystem may use one or more coding standards (e.g., RxNorm formedications, LOINC for laboratory and diagnostic orders, etc.), and thevirtual medical assistant may be configured to utilize such systems toplace an order in the correct form prior to dispatching the order to theappropriate order fulfillment system.

As discussed above, in accordance with some embodiments, a virtualmedical assistant may perform analysis on free-form instruction receivedfrom a medical professional to detect and provide an alert for potentialconflicts in connection with the order. This can be performed in anysuitable manner, some examples of which were discussed above. Forexample, when the orderable item is a medication, the dosage may bechecked by the virtual medical assistant to determine if it is between aminimum and maximum range, and/or its form and route may be checked forconsistency. As an another example, recent laboratory results for thepatient may be checked to ensure that the medication is compatible withthem (e.g., the patient's cholesterol level). As another example, druginteractions may be checked to ensure that the medication being orderedis compatible with medications on the patient's current medication list(drug-drug interaction). As yet another example, a check may be made fora medication to ensure that it is compatible with any allergies in thepatient's medical history (drug-allergy interaction). As anotherexample, drug interactions may be checked to assess whether a particulardrug is safe for use in connection with a medical condition(drug-condition interaction).

When the orderable item is a procedure, the virtual medical assistantmay check to see if the procedure is compatible with any medicationtaken by the patient (procedure-drug interaction), whether the procedureis safe for a patient with a given condition (procedure-conditioninteraction), or may detect any other conflicts or issues in connectionwith a specified procedure and a given patient. It should be appreciatedthat conflicts with respect to compatibility and/or suitability may bedetermined by a virtual medical assistant in connection with any one orcombination of order types understandable by the virtual medicalassistant, as the aspects are not limited in this respect. The virtualmedical assistant can perform such determinations in any suitablemanner, including using one or more CDS systems that include informationabout the suitability and compatibility of dosages, forms and routes ofmedication, compatibility between different types of medication,compatibility of medications with particular allergies, etc.

Described below are a number of example interactions between a medicalprofessional and a virtual medical assistant via a mobile device toillustrate various concepts and techniques related to virtual medicalassistance, according to some embodiments. The examples are described inconnection with the wireframes in FIGS. 4A-4H which schematicallyillustrate a virtual medical assistant application installed on a mobiledevice 401. FIGS. 4A-4H show an exemplary GUI 410 presented to a medicalprofessional by the virtual medical assistant application on a displayof mobile device 401 to allow the medical professional to utilizevirtual medical assistant functionality, some examples of which aredescribed below in connection with FIGS. 4A-4H.

FIG. 4A illustrates GUI 410 presented by a virtual medical assistant ona mobile device, in accordance with some embodiments. The general GUIfunctionality allows for a tap and speak discourse rendered in achat-like presentation on mobile device 401. In particular, dialog fromthe virtual medical assistant and from the medical professional aredisplayed in dialog icons on a display of mobile device 401. Amicrophone icon 413 is also presented on the display that the medicalprofessional can tap when the medical professional would like to speakan instruction, which the medical professional can speak in free-form.Spoken free-form instruction is captured by the mobile device andreceived by the virtual medical assistant application resident on themobile device. The received free-form instruction may then be processedby the virtual medical assistant by, for example, providing the receivedfree-form instruction to one or more network resources via wirelesscommunication component 406.

FIG. 4A illustrates an exemplary introductory presentation, for example,that may be presented when the medical professional activates thevirtual medical assistant (e.g., by launching the virtual medicalassistant application on the mobile device). In this example, thevirtual medical assistant application displays dialog (and may alsoaudibly render the dialog) indicating that virtual medical assistant isready to assist and provides guidance to the medical professional byinviting the medical professional to tap the microphone icon and tellthe virtual medical assistant what the medical professional would likedone. Initially, a medical professional may be unfamiliar withfunctionality provided by the virtual medical assistant and the virtualmedical assistant application may be present a menu of exemplary tasksthat the virtual medical assistant can assist the medical professionalwith or perform on behalf of the medical professional. To this end, themedical professional may say “What can you do for me?” and in responsethe virtual medical assistant application may present a number ofexample tasks the virtual medical assistant can perform by providingrepresentative free-form instruction suitable to instruct the virtualmedical assistant to perform the associated task, or begin the processof performing such a task. It should be appreciated that the medicalprofessional is not limited to speaking the same words presented in theexamples, as the virtual medical assistant may be configured to handlefree-form instruction. The menu of examples is intended to give themedical professional a flavor for how to interact with the virtualmedical assistant.

The exemplary tasks presented to the medical professional areillustrated in FIG. 4B and include making a telephone call to someone inthe medical professional's telephone directory, sending a message (e.g.,a text or email) to a designated recipient, requesting that the virtualmedical assistant show the medical professional's schedule, patient listor chart for a particular patient, ordering a medication, takingdictation (e.g., to memorialize the results of a patient encounter),etc. A given virtual medical assistant may choose to present any set ofpossible tasks that the virtual medical assistant can help with, or such“help” functionality may not be implemented at all, as this feature isused to illustrate possible functionality of a virtual medicalassistant.

FIG. 4C illustrates the results of the medical professional requestingthat the virtual medical assistant “show my patient list.” Inparticular, in response to the medical professional's free-forminstruction, the virtual medical assistant presents a list of themedical professional's patients, which may be obtained from a EHR systemor other location that maintains this information. As discussed above, avirtual medical assistant may receive instructions from the medicalprofessional in other ways besides speech. FIG. 4D illustrates theresult of the virtual medical assistant responding to the medicalprofessional selecting a patient from the patient list, for example, viatouch capabilities of the display. In particular, the virtual medicalassistant application may interpret the medical professional touchingthe display on the entry for a particular patient as instruction toretrieve the chart for this patient, which the virtual medical assistantmay obtain by accessing an EHR system. It should be appreciated that themedical professional could have provided this instruction using otherinput mechanism such as, for example, by providing free-form instructionby saying “show me [patient name's] chart,” or by typing such aninstruction via keypad.

Medical professionals often have busy schedules and may need assistancein scheduling appointments and/or may need reminders to perform certaintasks. An on-the-go medical professional may remember a task that needsto be completed, such as following up with a patient or medical staff inconnection with a patient, but may not at a given moment have the timeto follow-up, or it may not make logistic sense to do so at a giventime. The medical professional may utilize the virtual medical assistantto help manage their busy schedules by assisting in schedulingappointments or patient visits, setting up alerts and/or reminders,managing conflicts on the calendar, etc.

FIG. 4E illustrates a virtual medical assistant helping a medicalprofessional set-up a reminder. In particular, in the example shown inFIG. 4E, the medical professional speaks the free-form instruction “onApril 12^(th) remind me to follow-up with John Cartales,” and thefree-form instruction is received by the virtual medical assistant forprocessing. The medical professional does not specify the year, but thevirtual medical assistant may reasonably infer the year to be thecurrent year, and proceed to set-up a reminder for Apr. 12, 2013. Thevirtual medical assistant may present the reminder to the medicalprofessional and request that the medical professional confirm, eitherby presenting a touchable icon or other manually activated confirmation,processing a further free-form speech instruction, or both.Alternatively, the virtual medical assistant may set up the reminder andreport details of the completed task without asking for confirmationfrom the medical professional.

FIG. 4F illustrates a medical professional utilizing dictationfunctionality to capture free-form narration in connection with apatient encounter. For example, the medical professional may say “Pleasetake dictation for Jane Doe,” and the virtual medical assistant mayinterpret this instruction as the medical professional wishing toprovide a narrative regarding a patient encounter, such as a patientvisit, with Jane Doe. The virtual medical assistant may instruct themedical professional to tap the microphone and beginning speaking thenarrative. The free-from narrative may be captured by the device,received by the virtual medical assistant and processed to recognize thecontent of the dictation. The recognized dictation may be provided backto the user on the display via the virtual medical assistantapplication. According to some embodiments, the virtual medicalassistant may merely receive the audio and transfer the audio to anothersystem, e.g., a system that archives audio dictation for transcriptioneither by a transcriptionist or by an offline batch automaticrecognition system. According to some embodiments, the recognizeddictation (e.g., recognized by ASR component 130) is transmitted to anEHR system to be included in the patient's electronic medical record.According to some embodiments, the recognized dictation is provided toan NLU component to extract medical facts to add the facts to the EHRsystem according to the structure of the database. According to someembodiments, the virtual medical assistant may infer some informationabout the dictation and provide this information to populate fields inan EHR system (e.g., the virtual medical assistant may infer the datefrom the statement “Regarding Tuesday's visit . . . ” and may alsopopulate patient name information by virtue of receiving the instruction“Please take dictation for Jane Doe.”).

FIGS. 4G and 4H illustrate an example dialog between a virtual medicalassistant, wherein the medical professional utilizes the virtual medicalassistant to order medication for a patient. As shown in FIG. 4G, themedical professional speaks the free-form instruction: “Order amedication for Joe Petro,” which is received by the virtual medicalassistant application via the audio input capabilities of the mobiledevice. The virtual medical assistant application on the mobile devicemay then provide the free-form instruction to a medical understandingresource of the system for processing to recognize the medicalprofessional's speech and understand the speech content. In thisexample, the virtual medical assistant understands that the medicalprofessional would like to order a medication and recognizes thatadditional information is needed to complete the medical task ofsubmitting a medication order.

To begin the process of obtaining further information, the medicalvirtual assistant formulates the response: “Here's your medication orderfor Joe Petro. What medication?” and presents the response to themedical professional. In this example, the virtual medical assistant, inits response to the free-form instruction, both queries the medicalprofessional for further information and presents to the medicalprofessional a medication order filled out with the information gleanedby the virtual medical assistant from the free-form instruction, whichin the first instance consists primarily of the patient name and date ofbirth (which the virtual medical system may have obtained by accessing aEHR system, or other medical records system available to the virtualmedical assistant). Presenting the medication order to the medicalprofessional allows the medical professional to quickly confirm that thevirtual medical assistant understood the instruction and has identifiedthe correct patient so that the medical professional feels comfortableproceeding.

In the example illustrated in FIGS. 4G and 4H, in response to the queryregarding the medication, the medical professional responds by saying:“Medication name Laxix, dose is 40 mg, route is IV, start at 3 pm today.Please confirm.” The virtual medical assistant receives the free-formspeech instruction and processes the speech to extract informationneeded to complete the medication order. In this example, the virtualmedical assistant extracts the medication name, dose, route and time ofadministration and presents this information on the medication order forthe medical professional to review. It should be appreciated that any ofthe responses provided by the virtual medical assistant may be renderedas audio either alone or to supplement a visual display of the response.The virtual medical assistant application also presents a confirmationicon to the medical professional so that the medical professional canconfirm that the medication order is correct. While the medicalprofessional explicitly requested confirmation, the virtual medicalassistant may automatically await confirmation for any medical taskwhere confirmation is appropriate and/or required, thus facilitatingperformance of medical tasks with fewer mistakes and avoiding medicalerror. The virtual medical assistant may be configured to always requestconfirmation or may dispense with confirmation for certain task unlessthe medical professional requests confirmation, as the aspects are notlimited in this respect.

If the medical professional confirms that the medication order iscorrect (e.g., by tapping the “Confirm” icon, the virtual medicalassistant may generate a medication order formatted to conform to atarget ordering system (e.g., a desired CPOE system) and submit theorder for processing by the CPOE system to complete the medicationorder. In the example in FIGS. 4G and 4H, the medical professionalprovided the needed information in a single response. However, if thevirtual medical assistant required further information from the medicalprofessional, the discourse with the medical professional may continueuntil the information needed to complete the order is received.Additionally, any other impediment identified by the virtual medicalassistant, such as issues with drug interaction, dose or routeincompatibility or any questions the virtual medical assistant has inconnection with the medication order, may be worked out with the medicalprofessional via an appropriate dialog exchange between the medicalprofessional and the virtual medical assistant.

As discussed above, a virtual medical assistant may be configured todialog with a medical professional by rendering responses (e.g.,prompts, requests, inquiries, alerts, warnings, etc.) either visually oraudibly. With respect to audibly rendering responses, the virtualmedical assistant may employ speech synthesis techniques, either over anetwork or using local resources, to generate audio responses that canbe rendered, for example, using one or more speakers coupled to thedevice hosting the virtual medical assistant or using a separateinterface component. Providing audio responses may be used alone, or incombination with visual responses, or one or the other may be useddepending on the circumstances, environment or medical professionalpreference.

Table 1 below illustrates an example discourse between a medicalprofessional and a virtual medical assistant essentially conducted inaudio to allow, for example, the exchange to take place withoutrequiring the medical professional to visually focus on the deviceand/or in situations wherein the device being used by the medicalprofessional to interact with the virtual medical assistant does notinclude display functionality, or the virtual medical assistant does nothave access to display functionality of the device. In particular, thefree-form instruction may be provided by the medical professional usingspeech and the responses from the virtual medical assistant may berendered via audio using speech synthesis techniques and/or pre-recordedspeech. Such an audio mode may be preferable in certain circumstancessuch as when the medical professional's visual focus is trainedelsewhere (e.g., while driving, performing a procedure or otherwiseattending to a patient, etc.), when the display of the device hostingthe virtual medical assistant makes visual responses difficult orotherwise problematic, or visual responses are not possible (e.g., theinterface used by the medical professional does not include displaycapabilities such as a telephone call-in environment). An examplediscourse for ordering medication may proceed as follows.

TABLE 1 EXAMPLE AUDIBLE DIALOG Medical professional: Write a medicationorder for John Doe, give Furosemide 40 mg po stat Provider: CPOEmedication order info: Patient is John Doe, Medication Name Furosemide,Dose 40 mg, Route is po, Priority is stat, Start Time is Now. WhatMedication form? Medical professional: Form is pill Provider: CPOE orderinformation is complete: Patient is John Doe, Medication NameFurosemide, Dose 40 mg, Route is po, administration is pill form,Priority is stat, Start Time is Now. Medical professional: Correct,please proceed to order. Provider: There is a potential allergicreaction alert with this order. Do you want to change the order? Medicalprofessional: What is the problem? Provider: The patient is allergic topenicillin, of category PCN Cephalospor for the reasons of anaphylaxis.Medical professional: Override the alert, the patient is not trulyallergic. Provider: Okay, overriding the allergy alert with overridingreason that the patient is not truly allergic. Please speak your voicesignature to override. Medical professional: <Voice Signature> Provider:Thank you, CPOE order for John Doe has been submitted, order number is#######. Do you wish to make another order? Medical professional: Yes,order Levofloxacin 5000 mg IV for 3 days everyday dose now, then routineschedule times. Provider: CPOE medication order for John Doe, Medicationname Levoflaxin, dose 5000 mg, route IV, frequency every day for 3 days.Start dose now, then routine schedule times. Please confirm that this iscorrect and provide any special instructions? Medical professional: Yes,correct. No special instructions. Provider: The dose of 5000 mg isgreater than recommended dose of 500 mg according to National Drug DataFile recommendation. How would you like to proceed? Medicalprofessional: Override. The reason is a ABN kidney function. Provider:Okay, overriding the min/max dose alert with overriding reason of ABNkidney function. Please say your voice signature to override. Medicalprofessional: <Voice Signature> Provider: Thank you. Medication orderfor John Doe has been submitted, order number is #######. Do you wish tomake another order? Medical professional: Not right now.

It should be appreciated that the above discourse may also beimplemented using visual responses (e.g., using any of the visualdisplay techniques illustrated in FIGS. 4A-4H, or any other suitabledisplay technique or format) and/or medical professional input may bereceived in ways other than speech (e.g., via keypad, touch icons,etc.), as the example in Table 1 is merely illustrative of one possibleway of conducting a dialog with a medical professional that may besuitable (or advantageous) in certain situations, while visual displaymay be used and/or preferred in other situations.

The example discourse illustrated in Table 1 demonstrates the use ofdialog and inference techniques to discourse with the medicalprofessional to understand and help complete the medical task of placinga medication order. In particular, in multiple instances, the virtualmedical assistant provided responses to the medical professional toobtain further information regarding the medication order (e.g., requestmissing information such as medication form, inquire as to specialinstructions, etc.) and/or alert the medical professional to conflictsin connection with the medication order (e.g., drug-allergy alert,min/max dose alert).

In addition, in the example discourse illustrated in Table 1, thevirtual medical assistant obtains information by inference frompreviously received instruction and/or information obtained as a resultof previously received instruction. For example, the medicalprofessional's second medication order (e.g., Levofloxacin) did notinclude the name of the patient but the virtual medical assistantinferred that the patient was the same as for the previous order.

A virtual medical assistant may be configured with security measuressuch as any one or combination of password protection, voiceverification/authentication, signature verification/authentication, etc.to verify and/or confirm that a user providing free-form instruction isauthorized to perform one or more medical tasks specified in free-forminstruction received from the user. Any suitable security techniques maybe utilized, as the aspects are not limited in this respect.

An illustrative implementation of a computer system 500 that may be usedto implement one or more virtual medical assistant techniques describedherein is shown in FIG. 5. Computer system 500 may include one or moreprocessors 510 and one or more non-transitory computer-readable storagemedia (e.g., memory 520 and one or more non-volatile storage media 530).The processor 510 may control writing data to and reading data from thememory 520 and the non-volatile storage device 530 in any suitablemanner, as the aspects of the invention described herein are not limitedin this respect. Processor 510, for example, may be a processor on amobile device.

To perform functionality and/or techniques described herein, theprocessor 510 may execute one or more instructions stored in one or morecomputer-readable storage media (e.g., the memory 520, storage media,etc.), which may serve as non-transitory computer-readable storage mediastoring instructions for execution by processor 510. Computer system 500may also include any other processor, controller or control unit neededto route data, perform computations, perform I/O functionality, etc. Forexample, computer system 500 may include any number and type of inputfunctionality to receive data and/or may include any number and type ofoutput functionality to provide data, and may include control apparatusto perform I/O functionality.

In connection with identifying task(s) specified in free-forminstruction, one or more programs configured to receive free-forminstruction, process the instruction or otherwise execute functionalitydescribed herein may be stored on one or more computer-readable storagemedia of computer system 500. In particular, some portions or all of avirtual medical assistant may be implemented as instructions stored onone or more computer-readable storage media. Processor 510 may executeany one or combination of such programs that are available to theprocessor by being stored locally on computer system 500 or accessibleover a network. Any other software, programs or instructions describedherein may also be stored and executed by computer system 500. Computersystem 500 may represent the computer system on a host device on which avirtual medical assistant application is installed and/or may representthe computer system on which any one or combination of network resourcesare implemented (e.g., any one or combination of components forming avirtual medical assistant, or other network resource). Computer system500 may be implemented as a standalone computer, server, part of adistributed computing system, and may be connected to a network andcapable of accessing resources over the network and/or communicate withone or more other computers connected to the network (e.g., computersystem 500 may be part of the network resources available to a virtualmedical assistant).

The terms “program” or “software” are used herein in a generic sense torefer to any type of computer code or set of processor-executableinstructions that can be employed to program a computer or otherprocessor to implement various aspects of embodiments as discussedabove. Additionally, it should be appreciated that according to oneaspect, one or more computer programs that when executed perform methodsof the disclosure provided herein need not reside on a single computeror processor, but may be distributed in a modular fashion amongdifferent computers or processors to implement various aspects of thedisclosure provided herein.

Processor-executable instructions may be in many forms, such as programmodules, executed by one or more computers or other devices. Generally,program modules include routines, programs, objects, components, datastructures, etc. that perform particular tasks or implement particularabstract data types. Typically, the functionality of the program modulesmay be combined or distributed as desired in various embodiments.

Also, data structures may be stored in one or more non-transitorycomputer-readable storage media in any suitable form. For simplicity ofillustration, data structures may be shown to have fields that arerelated through location in the data structure. Such relationships maylikewise be achieved by assigning storage for the fields with locationsin a non-transitory computer-readable medium that convey relationshipbetween the fields. However, any suitable mechanism may be used toestablish relationships among information in fields of a data structure,including through the use of pointers, tags or other mechanisms thatestablish relationships among data elements.

Also, various inventive concepts may be embodied as one or moreprocesses, of which multiple examples have been provided. The actsperformed as part of each process may be ordered in any suitable way.Accordingly, embodiments may be constructed in which acts are performedin an order different than illustrated, which may include performingsome acts concurrently, even though shown as sequential acts inillustrative embodiments.

All definitions, as defined and used herein, should be understood tocontrol over dictionary definitions, and/or ordinary meanings of thedefined terms.

As used herein in the specification and in the claims, the phrase “atleast one,” in reference to a list of one or more elements, should beunderstood to mean at least one element selected from any one or more ofthe elements in the list of elements, but not necessarily including atleast one of each and every element specifically listed within the listof elements and not excluding any combinations of elements in the listof elements. This definition also allows that elements may optionally bepresent other than the elements specifically identified within the listof elements to which the phrase “at least one” refers, whether relatedor unrelated to those elements specifically identified. Thus, as anon-limiting example, “at least one of A and B” (or, equivalently, “atleast one of A or B,” or, equivalently “at least one of A and/or B”) canrefer, in one embodiment, to at least one, optionally including morethan one, A, with no B present (and optionally including elements otherthan B); in another embodiment, to at least one, optionally includingmore than one, B, with no A present (and optionally including elementsother than A); in yet another embodiment, to at least one, optionallyincluding more than one, A, and at least one, optionally including morethan one, B (and optionally including other elements); etc.

The phrase “and/or,” as used herein in the specification and in theclaims, should be understood to mean “either or both” of the elements soconjoined, i.e., elements that are conjunctively present in some casesand disjunctively present in other cases. Multiple elements listed with“and/or” should be construed in the same fashion, i.e., “one or more” ofthe elements so conjoined. Other elements may optionally be presentother than the elements specifically identified by the “and/or” clause,whether related or unrelated to those elements specifically identified.Thus, as a non-limiting example, a reference to “A and/or B”, when usedin conjunction with open-ended language such as “comprising” can refer,in one embodiment, to A only (optionally including elements other thanB); in another embodiment, to B only (optionally including elementsother than A); in yet another embodiment, to both A and B (optionallyincluding other elements); etc.

Use of ordinal terms such as “first,” “second,” “third,” etc., in theclaims to modify a claim element does not by itself connote anypriority, precedence, or order of one claim element over another or thetemporal order in which acts of a method are performed. Such terms areused merely as labels to distinguish one claim element having a certainname from another element having a same name (but for use of the ordinalterm).

The phraseology and terminology used herein is for the purpose ofdescription and should not be regarded as limiting. The use of“including,” “comprising,” “having,” “containing”, “involving”, andvariations thereof, is meant to encompass the items listed thereafterand additional items.

Having described several embodiments of the techniques described hereinin detail, various modifications, and improvements will readily occur tothose skilled in the art. Such modifications and improvements areintended to be within the spirit and scope of the disclosure.Accordingly, the foregoing description is by way of example only, and isnot intended as limiting. The techniques are limited only as defined bythe following claims and the equivalents thereto.

What is claimed is:
 1. A method of using a virtual medical assistant toassist a medical professional, the virtual medical assistantimplemented, at least in part, by at least one processor of a hostdevice capable of connecting to at least one network, the methodcomprising: receiving free-form instruction from the medicalprofessional; providing the free-form instruction for processing toassist in identifying, from the free-form instruction, at least onemedical task to be performed; obtaining identification of at least oneimpediment to performing the at least one medical task; and inferring atleast some information needed to overcome the at least one impediment.2. The method of claim 1, wherein the free-form instruction is processedby a natural language understanding component to identify informationexpressed in the free-form instruction indicating an intent to performthe at least one medical task.
 3. The method of claim 2, wherein the atleast some information is inferred, at least in part, from previouslyreceived free-form instruction, information obtained responsive to thepreviously received free-form instruction, an electronic medical recordassociated with a patient and/or a medical information resourceaccessible over the at least one network.
 4. The method of claim 3,wherein the identified at least one impediment includes one or moreimpediments selected from a group consisting of: an identification ofinformation missing from the free-form instruction needed to perform theat least one medical task, at least one ambiguity in connection withperforming the at least one medical task, an inability to identify theat least one medical task with sufficient certainty, and one or moreconflicts in connection with performing the at least one medical task.5. The method of claim 4, wherein the at least one medical taskidentified from the free-form instruction includes a request to order anorderable item, the request to order the orderable item including anorder selected from the group consisting of: a medication order, aprocedure order, a lab order, a diagnostic test order, an appointmentorder, a referral order, and a consultation order.
 6. The method ofclaim 5, wherein inferring at least some information comprises inferringat least some information needed to complete the order of the orderableitem, the method further comprising submitting an electronic order forthe orderable item.
 7. The method of claim 5, wherein the identifiedrequest to order the orderable item includes a request to order amedication, and wherein inferring the at least some information includesinferring at least one of a dose of the medication, a frequency ofadministration of the medication, and a route of administration of themedication.
 8. The method of claim 3, wherein a previously receivedfree-form instruction comprises a request from the medical professionalto view patient information for a patient, and wherein inferring atleast some information comprises inferring at least some informationfrom the patient information received responsive to the command and/orfrom an electronic medical record associated with the patient identifiedin the command.
 9. The method of claim 1, wherein receiving the freeform instruction comprises receiving free-form speech instruction fromthe medical professional, and wherein providing the free-forminstruction for processing comprises transmitting the free-form speechinstruction over the at least one network to an automatic speechrecognition component to recognize at least a portion of the free-formspeech instruction, and wherein the recognized free-form speechinstruction is provided to a natural language understanding component toassist in identifying the at least one medical task to be performed. 10.(canceled)
 11. At least one computer readable medium storinginstructions that, when executed on at least one processor, perform amethod of using a virtual medical assistant to assist a medicalprofessional, the virtual medical assistant implemented, at least inpart, by at least one processor of a host device capable of connectingto at least one network, the method comprising: receiving free-forminstruction from the medical professional; providing the free-forminstruction for processing to assist in identifying from the free-forminstruction at least one medical task to be performed; obtainingidentification of at least one impediment to performing the at least onemedical task; and inferring at least some information needed to overcomethe at least one impediment.
 12. The at least one computer readablemedium of claim 11, wherein the free-form instruction is processed by anatural language understanding component to identify informationexpressed in the free-form instruction indicating an intent to performthe at least one medical task.
 13. The at least one computer readablemedium of claim 12, wherein the at least some information is inferred,at least in part, from previously received free-form instruction,information obtained responsive to the previously received free-forminstruction, an electronic medical record associated with a patientand/or a medical information resource accessible over the at least onenetwork.
 14. The at least one computer readable medium of claim 13,wherein the identified at least one impediment includes one or moreimpediments selected from a group consisting of: an identification ofinformation missing from the free-form instruction needed to perform theat least one medical task, at least one ambiguity in connection withperforming the at least one medical task, an inability to identify theat least one medical task with sufficient certainty, and one or moreconflicts in connection with performing the at least one medical task.15. The at least one computer readable medium of claim 14, wherein theat least one medical task identified from the free-form instructionincludes a request to order an orderable item, the request to order theorderable item including an order selected from the group consisting of:a medication order, a procedure order, a lab order, a diagnostic testorder, an appointment order, a referral order, and a consultation order.16. The at least one computer readable medium of claim 15, whereininferring at least some information comprises inferring at least someinformation needed to complete the order of the orderable item, themethod further comprising submitting an electronic order for theorderable item. 17-20. (canceled)
 21. A host device capable ofconnecting to at least one network, the host device comprising: at leastone processor implementing, at least in part, a virtual medicalassistant to assist a medical professional, the at least one processorconfigured to: receive free-form instruction from the medicalprofessional; provide the free-form instruction for processing to assistin identifying from the free-form instruction at least one medical taskto be performed; obtain identification of at least one impediment toperforming the at least one medical task; and infer at least someinformation needed to overcome the at least one impediment.
 22. The hostdevice of claim 21, wherein the free-form instruction is processed by anatural language understanding component to identify informationexpressed in the free-form instruction indicating an intent to performthe at least one medical task.
 23. The host device of claim 22, whereinthe at least some information is inferred, at least in part, frompreviously received free-form instruction, information obtainedresponsive to the previously received free-form instruction, anelectronic medical record associated with a patient and/or a medicalinformation resource accessible over the at least one network.
 24. Thehost device of claim 23, wherein the identified at least one impedimentincludes one or more impediments selected from a group consisting of: anidentification of information missing from the free-form instructionneeded to perform the at least one medical task, at least one ambiguityin connection with performing the at least one medical task, aninability to identify the at least one medical task with sufficientcertainty, and one or more conflicts in connection with performing theat least one medical task.
 25. The host device of claim 24, wherein theat least one medical task identified from the free-form instructionincludes a request to order an orderable item, the request to order theorderable item including an order selected from the group consisting of:a medication order, a procedure order, a lab order, a diagnostic testorder, an appointment order, a referral order, and a consultation order.26-30. (canceled)